Unfallchirurg最新文献

Do drones have the potential to become established as a new member of the rescue chain? This article attempts to provide answers to this important question. In addition to a brief historical review, the many possible applications are described. The contents of selected research projects are also presented. This shows how far developments have come today and which applications are conceivable in the near future. The associated challenges, such as compliance with legal requirements or training, are also addressed.

The Bavarian Mountain Rescue Service has always shown a great interest in innovations, chances and possibilities. Against this background, in 2012 the construction of a new structure was initiated, the localization, communication and situation report team (LKLD: Lokalisation, Kommunikation und Lagedarstellung), which uses modern techniques, such as the GPS, mobile internet, thermal imaging, residual light amplification and drones. The use of unmanned aircraft systems (UAS) has already been proven to be very helpful and facilitative in the search for missing persons. Using UAS the LKLD teams could also successfully master unusual missions, e.g. for the inspection of damaged structures in the bridge construction after the tragic collapse of the bridge in Werneck or in connection with monitoring of dangerous alpine conditions. Motivated by these successes and by the political appreciation of their voluntary work, dedicated work is being carried out on further innovations. Under consideration are automated flights far beyond the range of visibility, transport of materials and drones which can carry passengers.

Background: The number of primary arthroplasties is increasing and the proportion of revision arthroplasties is becoming increasingly more important. The need for standardized and guideline-based diagnostics for the safe detection of a periprosthetic joint infection (PJI) is becoming apparent. In the past 10 years various organizations have published definitions and diagnostic guidelines. The implementation of an inhouse standard test kit could help to simplify the process and could improve the diagnostic quality.

Method: In 2016 a test kit was compiled in a monocentric prospective study, taking the International Consensus Meeting (ICM) criteria 2014 and the Infectious Diseases Society of America (IDSA) criteria into account, which also fulfils the definitions of the ICM criteria 2018 and criteria of the European Bone and Joint Infection Society 2021. The test kit was implemented in the clinical setting of a special department for aseptic and septic revision arthroplasty. The usability and accuracy of the test kit were examined.

Results: The test kit was implemented using blood samples (leukocyte count; C‑reactive protein, CRP), samples for examining the synovial fluid (white blood cell count, PMN cell differentiation, microbiological culture for incubation over 14 days, alpha-defensin enzyme-linked immunosorbent assay, ELISA, leukocyte esterase test strips) together with information and request forms. Between April 2016 and February 2020 a total of 405 patients were investigated. Within 3 calendar years, the use of the test kit increased from 59% initially to 86%, and finally to 96% of cases in the third calendar year. The leukocyte esterase test strip was reliable in only 72%, due to undifferentiated readability or blood contamination. The costs increased by the only commercially available alpha-defensin ELISA test by approx. 52€ per puncture. The best individual test showed a sensitivity/specificity of 92.8%/95.2% with alpha-defensin. It was calculated which combinations showed a similar test quality and different combinations, such as CRP+ cell count+ microbiology showed a sensitivity/specificity both of around 90%. Metallosis is a challenge for preoperative PJI diagnostics.

Discussion: In a prospective study it was shown, that the implementation of the standardized test kit lead to a guideline based PJI diagnostic in all cases and thus to a significantly increase of the diagnostic quality. There is currently no single test that reliably excludes or proves an infection. The alpha-defensin laboratory ELISA test showed the best test accuracy, whereby the consideration of test combinations is obligatory and at the same time safe.

Background: The search for and rescue of missing persons is always coupled with a high demand on human resources. In cases of suspected drowning it is often necessary to search huge expanses of water. For depths of more than 3-5 m the search and rescue procedure needs to be performed by specialist rescue divers. Due to saturation with nitrogen caused by the higher ambient pressure during the dive, the operating time for each rescue diver is limited. In addition, each dive is linked with an increased risk.

Objective: Miniaturization of sensors, higher performance of embedded systems and high energy density of modern accumulators offer the chance to operate with unmanned flying and diving vehicles for search and rescue even with moderate financial investment.

Material and methods: Based on funding by the Federation of the German Live Saving Association (DLRG) the DLRG national association of Bavaria procured three different models of remotely operated underwater vehicles (ROUV) and two different systems for underwater positioning. These systems will be offered to local associations of the DLRG in Bavaria for intense testing in their waters based on a common implementation strategy to ensure comparability and reproducibility.

Results: Initial tests with different types of ROUV and underwater positioning have been performed in preparation of the survey. As a result, mini-ROUVs found in the lower consumer segment have been identified as insufficient as they are not able to carry the additional payload of the underwater positioning systems whilst maintaining controllability. In contrast, more complex drones are difficult to handle and require longer preparation times before they are ready for use. The ROUVs in the median range, preferably with a streamlined structure, have so far been found to be optimal; however, operating the vehicle without a positioning system is not recommended.

Conclusion: In combination with an underwater positioning system, remotely operated underwater vehicles are identified as a reasonable supplement for rescue divers. Fast time to operation enables a preview of the operating area before starting the rescue operation and can therefore support the rescue diver team.